By Karen Taylor, Director, and Pratik Avhad, Senior Analyst, Centre for Health Solutions
This week the Deloitte Academy hosted its latest ‘The Deloitte Quarterly Forward Look’ where I and my fellow Insight colleagues discussed what we are seeing and expect to happen over the next three months. My focus was on the public health impact of the COVID-19 pandemic, both globally and in the UK. I was supported in my preparation for this webinar by research from my senior analyst, Pratik Avhad, who has supported me in understanding the evolving story of the pandemic over the past 18 months. I thought I would use this week’s blog to share some of our latest research on infection numbers, vaccinations and the likelihood of another lockdown in the coming months.The current scale and extent of COVID-19 infections and related outcomes
As we all know, this is a global pandemic with almost every geography affected. As of 7 September, over 221 million COVID-19 cases had been reported worldwide, but encouragingly this is a 13 per cent decline in cases over the past the past seven days. So far, at least 4.6 million people have died of/or with COVID-19 and importantly, more than 5.5 billion vaccine doses have been administered. The US continues to have the highest cumulative number of confirmed cases (over 40 million) and deaths (over 666,000) globally. The next highest is India with over 33 million cases, followed by Brazil (almost 21 million), and Russia, the UK and France all reporting a cumulative total of around 7 million cases. Indeed, 15 countries have now reported over three million cases. In terms of the numbers of deaths per million population Brazil, with 2,724 cases per million population, is the highest of the top 12 countries followed by Argentina (2,466), Columbia (2,433), Italy (2,147), the US (2,000) and the UK (1,951).1
Notably, over the past seven days, all five continents have reported a decline in new cases, North America and Africa have seen declines (20 and 22 per cent respectively), Asia (11 per cent), South America (15 per cent), with Europe seeing an overall decline of just one per cent. These figures also hide wide variations with individual countries across the world experiencing new surges in infections, such as Croatia, Germany and the UK (Figure 1). Meanwhile, Thailand, Australia and New Zealand, who have seen relatively small numbers of cases are also seeing surges in infections caused by the new Delta variant. In the US, in August, COVID-19 hospitalisations in 10 states hit record highs and positive cases among children are nearing their January peak.2
Figure 1. The weekly changes in numbers of cases and deaths over the last seven days
Note: Last updated: 07 September 2021, 01:56GMT
The rollout of the vaccination schedule and current position
The UK’s COVID-19 vaccination programme is an ongoing mass immunisation campaign. The UK was the first mover in the vaccination rollout, starting on 8 December 2020, with the regulatory approval of the Pfizer-BioNTech vaccine. This was closely followed by approval of the Oxford-AstraZeneca vaccine, as Phase 1 of the rollout, prioritising the most vulnerable, in a schedule primarily based on age commenced. On 30 December 2020, the delivery schedule was adjusted to extend the gap between the first and second dose to 12 weeks so that more people could receive their first dose. On 4 January 2021, the government set a target to give all 15 million people in the top four priority groups their first dose by the middle of February 2021. This was achieved on 14 February 2021.
The next five priority groups were offered a vaccine by 15 April, with 32 million doses administered by that point. In June 2021, all adults aged 18+ were eligible for their first dose of a vaccine, which by then also included the Moderna vaccine. The programme was expanded to all children aged 16 and 17 who were able to get their first dose of the Pfizer-BioNTech vaccine in August 2021.3 By 6 September 2021, 80 per cent of people aged 16 and over in the UK have received two doses and 89 per cent their first dose, an impressive achievement that compares very favourably with most countries across the world (Figure 2).
Figure 2. Overview of the countries with the most progress in vaccinating their populations against COVID-19 (as at 5 September 2021)
Source: Our World in Data; Gov UK
Should 12-15-year-olds have the COVID-19 vaccine and what is the risk of long-COVID-19?
One area that has sparked controversy is the question of vaccinating 12-15-year-olds given the growing concern that the return to school in Scotland in mid-August has contributed to a spike in infections.4 The decision of the Government’s advisory body, the Joint Committee on Vaccination and Immunisation (JCVI), on 3 September was that the medical evidence alone did not warrant mass vaccination of 12-15-year-olds and recommended that vaccines should only be made available to those who have one of a number of serious medical conditions and/or severely weakened immune systems.5 The JCVI suggested that the final decision should be ceded to the UK’s four Chief Medical Officers who could take into account wider factors.6
This decision, however, makes the UK only one of two comparator countries — Sweden being the other — not to have approved vaccinating this age group. Meanwhile, countries like Israel, Italy, France, Germany and Canada have started vaccinating their 12-15-year-olds. The crux of the decision by the JCVI panel on Friday was its view that the health benefits of the vaccine for younger teenagers were marginally outweighed by possible side-effects (due to concerns that the two main mRNA vaccines used in younger adults have been associated with heart inflammation in one in every 20,000 young people).7
This decision did not take into account the wider impacts of contracting COVID-19 which is outside the remit of the JCVI. These include disruption to schooling and also the risk of developing long-COVID, with one research paper suggesting that one in seven children who contracted COVID developed longer term repercussions.
This research, led by University College London and Public Health England, found that at an average of 15 weeks after having a PCR-test, 14 per cent (one in seven) more 11-17-year-olds in the test positive group had three or more symptoms of ill health, including unusual tiredness and headaches, than those in the test negative group, while one in 14 (seven per cent) had five or more symptoms.8 Furthermore, long-COVID is likely to have an impact on schooling and increase demand on the health system. The decision on whether to vaccinate 12-15-year-olds is, therefore, now with the UK’s Chief Medical Officers.
The likelihood of another lockdown in UK over the next quarter?
In England, the Government lifted all COVID-19 restrictions on 19 July. However, since then the UK has seen an average of 31,000 cases a day, largely driven by the more infectious Delta variant.9 At the same time, 80 per cent of the 16+ population have received both doses of the vaccine and around 89 per cent at least one dose. The progress in vaccinations and the research evidence on impact of infections demonstrates clearly that vaccinations have weakened the link of infection with hospitalisations and deaths.10
While the actual number of reported cases are similar to the mid-January peak, among those aged 45 to 54 years, admissions are only a quarter of those in mid-January, and, among those aged 85 years and over, they are nine times lower.11 However, admission rates in the youngest age groups are similar to those seen in mid-January. Specifically, admission rates of those aged 5 to 14 years during the last week of August was at 84 per cent of the mid-January level, while the rate in those under five years of age was 114 per cent of the rates seen in the week ending 17 January 2021.12
These differences in admissions reflect the age prioritisation of the vaccination programme. Nevertheless, many economists and epidemiologists are increasingly confident that the UK’s recovery will be able to withstand an autumn rise in coronavirus cases even as school term starts, workers return to offices and people socialise more indoors; largely due to the effectiveness of vaccines in limiting severe disease. However, there is a ‘caveat’ which may require this position to be revisited should the ‘virus change substantially and the risk of new variants that resist the vaccines emerge’. This risk will be with us as long as the virus is in circulation; but even then, alternatives to a full lock down are likely such as the return of mask wearing, social distancing and the much-debated proposal for vaccine passports.